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Authorization Nurse RN 26-66 at Hill Physicians Medical Group - ApplyBlast

Authorization Nurse RN 26-66

Hill Physicians Medical Group

4 months ago

3.6 on Glassdoor

San Ramon, California

Onsite

Full Time

Senior

0 applicants

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About this role

A Utilization Review Nurse at Hill Physicians evaluates medical authorization requests to ensure appropriate, efficient, and timely care for members with chronic conditions. This role involves collaborating with physician leaders on clinical decisions, processing urgent and non-urgent requests, and utilizing specific medical criteria like Milliman Care Guidelines. The position requires reviewing provider data, communicating with stakeholders, and assisting in resolving complex authorization process issues.

Responsibilities

Evaluate and authorize medical necessity requests according to established criteria
Collaborate with Medical Directors on complex clinical decisions
Communicate authorization status to providers and patients
Process urgent, routine, and retrospective authorizations efficiently
Refer cases to Case Management or other departments for follow-up

Skills

Qualifications

Registered Nurse (RN) LicenseLicensed Vocational Nurse (LVN) LicenseCalifornia Nursing LicenseUtilization Management Certification

About Hill Physicians Medical Group

hillphysicians.com

Headquarters

San Ramon, California, United States

Company Size

501-1000 employees

Founded

1984

View Profile

We deliver top-tier healthcare across the San Francisco Bay, Sacramento, and Central Valley regions. Hill Physicians is supported by PriMed Management Consulting Services, offering comprehensive management and support to ensure exceptional care for our members."